Facebook Dr. Ramon Reyes, MD

NIVEL DE ALERTA ANITERRORISTA, España

sábado, 22 de junio de 2013

NIOSH Continues Research to Improve Safety for Ambulance Service Workers and EMS Responders

Transportation incidents are the leading cause of work-related
deaths in the United States; between 2003 and 2009, an average of almost
1,300 U.S. workers died from roadway crashes each year. The risk is
even greater for emergency medical services (EMS) personnel. In 2002
field investigators estimated that the fatality rate for EMS workers was
more than 2 times the national average for all workers.2
As part of the National Occupational Research Agenda (NORA),
researchers at the National Institute for Occupational Safety and Health
(NIOSH) set out to reduce ambulance crash–related injuries and deaths
among EMS workers. Research addressed the layout and structural
integrity of ambulance compartments, design of hardware, and occupant
restraints.
NIOSH research revealed a number of important factors involved in
ambulance worker injuries and deaths. For example, field investigators
observed that EMS workers often ride on the squad bench without wearing
a restraint. This allows them to lean forward, stand up, or change
positions as needed to reach the patient or equipment, but places them
at higher risk of striking bulkheads, cabinets, shelves, or other
occupants during a crash. NIOSH crash tests also revealed the
possibility of head injury if a worker’s head strikes the cabinets
immediately above or behind them, and noted that vehicle structural
failures can be a contributing factor in adverse outcomes of EMS
crashes.

Impact

In 2007 NIOSH partnered with the Ambulance Manufacturers Division of
the National Truck Equipment Association (AMD-NTEA) and the General
Services Administration (GSA) to revise the GSA ambulance purchase
specification and the companion AMD-NTEA test standards. This included
increasing the head clearance for EMS workers above the seating
positions, eliminating a significant source of head injury. NIOSH also
worked with AMD-NTEA to establish a new crash test methodology Technical
Committee. The committee used NIOSH research to develop a
cost-effective test procedure to evaluate how components (seats, cot,
equipment mounts) in a patient compartment would withstand a 30 mph
frontal impact. This test procedure was published by the Society of
Automotive Engineers (SAE) in May of 2010 as a recommended practice, and
is already being used within the industry to improve ambulance seating
and restraints. The team has developed a companion document covering
vehicle response in side impact events, which SAE is expected to publish
in late Summer 2011. The long-term goal is to bring ambulance patient
compartments up to the same level of safety found in passenger vehicles.

NIOSH researchers continue to work with AMD-NTEA, GSA, manufacturers,
and federal agencies on other recommendations to improve occupational
safety for EMS workers. Ongoing efforts include creating and validating
individual standards for seating and worker restraints, litter and
patient restraints, and equipment mounting. These research-to-practice
measures and collaborative efforts will improve the safety of EMS crew
members in their mission to save the lives of others.

Relevant Information

About 218,000 emergency medical technicians and paramedics were employed in 2009, according to the Bureau of Labor Statistics.4

Between 500,000–800,000 workers are estimated to volunteer as
emergency medical technicians or paramedics in addition to the 218,000
employed personnel. These figures do not include the many additional
firefighters who are also trained in emergency medical services.

Doctors call for global consensus on diagnosis of death

There needs to be international agreement on when and how death is diagnosed, two leading doctors suggest.

At a European meeting of anaesthetists they said improvements in technology mean the line between life and death is less clear.

They called for precise guidelines and more research to
prevent the rare occasions when people are pronounced dead but are later
found to be alive.

The World Health Organisation has begun work to develop a global consensus.

In the majority of cases in hospitals, people are pronounced
dead only after doctors have examined their heart, lungs and
responsiveness, determining there are no longer any heart and breath
sounds and no obvious reaction to the outside world.

'Permanent damage to brain'

But Dr Alex Manara, a consultant anaesthetist at Frenchay
Hospital in Bristol, said more than 30 reports in medical literature,
describing people who had been determined dead but later found to be
alive, had driven scientists to question whether the diagnosis of death
can be improved.

At a meeting of the European Society for Anaesthesiology he
said that on some occasions doctors do not observe the body for long
enough before someone is declared dead.

"Italians and Brits are probably built in the same way - it makes sense to have the same criteria for death for both” Dr Jerry Nolan Consultant in intensive care, Bath Royal United Hospital, UK

Dr Manara called for internationally agreed
guidelines to ensure doctors observe the body for five minutes, in order
not to miss anyone whose heart and lungs spontaneously recover.

Many institutions in the US and Australia have adopted two
minutes as the minimum observation period, while the UK and Canada
recommend five minutes. Germany currently has no guidelines and Italy
proposes that physicians wait 20 minutes before declaring death,
particularly when organ donation is being considered.

Dr Jerry Nolan, consultant in intensive care at the Royal
United Hospital in Bath, who is not involved in the conference, said:
"In hospitals, where patients are monitored closely, and after the
appropriate resuscitation has taken place, waiting five minutes to
observe the body is a good idea.

"There is evidence to show that once you start going beyond
five minutes without a circulation or oxygen to the brain you start
seeing permanent damage to brain cells."

At the conference, Ricard Valero, professor of anaesthesia at
the University of Barcelona, considered the rarer scenario of patients
in intensive care units whose hearts and lungs are kept functioning by
machines.

In such scenarios, doctors use the concept of brain death -
often conducting neurological tests to monitor any brain activity in the
patient.

'Variations don't seem logical'

But the criteria used to establish brain death have slight variations across the globe.

In Canada, for example, one doctor is needed to diagnose
brain death; in the UK, two doctors are recommended; and in Spain three
doctors are required. The number of neurological tests that have to be
performed vary too, as does the time the body is observed before death
is declared.

"These variations in practice just do not seem logical," Prof Valero said.

He proposed further research to support a global consensus on the most appropriate criteria to diagnose brain death.

Dr Nolan said: "In principle an international guideline on
death is a very good idea. It is likely to help in terms of the movement
of doctors between countries and, importantly, with public confidence.

"Italians and Brits are probably built in the same way. It makes sense to have the same criteria for death for both."